4．巨大腫瘍に対する開胸アプローチ

Thoracotomy Approach to Large Tumors

一側胸腔内を占拠するような巨大な腫瘍に対する手術では，腫瘍の局在，大きさだけでなく，腫瘍の取り回し，大血管や気管などの隣接する重要臓器へのアクセス，腫瘍の浸潤範囲や合併切除臓器などを考慮した手術戦略が必要となる．安全で質の高い手術を遂行するためには良好な術野を得ることが必須で，どのような手術アプローチで行うかが重要である．

Surgery for large tumors that occupy one side of the thoracic cavity requires a surgical strategy that considers not only the localization and size of the tumor but also tumor manipulation, access to adjacent vital organs such as the pulmonary arteriovenous, the tumor infiltration range, and combined organ resection. To perform safe and high-quality surgery, it is necessary to obtain a good surgical field, and determining the optimal surgical approach to use is also important. Thoracotomies include posterolateral thoracotomy, rib-cross thoracotomy, clamshell thoracotomy, hemi-clamshell thoracotomy, and transmanubrial osteomascular-sparing approach. Anatomical proficiency, preoperative imaging evaluation, thoracotomy simulations, and meetings with anesthesiologists are also important.